OBJECTIVES: Approximately 50% of diabetic patients will develop some type of renal damage throughout their lifetime. The current screening method for diabetic nephropathy (DN) is based upon detection of albumin in the urine and decline of glomerular filtration rate, which occurs relatively late in the course of the disease . We developed a polygenic risk score (PRS) for early prediction of the risk for type 2 diabetes (T2D) patients to develop DN. The aim of this study was to assess the economic impact of the implementation of the PRS for the prevention of DN in T2D patients, compared to usual screening methods, in Canada.

METHODS: A Markov model was developed using 1-year cycles and a 5-year time-horizon. Markov health states were defined as: pre-end-stage renal disease (Pre-ESRD), ESRD and death. Model efficacy parameters were calculated based on prediction of outcome data by polygenic risk testing of the ADVANCE trial. Analyses were conducted from Canadian healthcare and societal perspectives. The primary outcome was the incremental cost-utility ratio. Scenario analyses were conducted using time-horizons of 10 and 25-years. Deterministic and probabilistic sensitivity analyses (DSA;PSA) were conducted to assess the robustness of the results

RESULTS: Over a lifetime horizon, the PRS was a dominant strategy, from both a healthcare system and societal perspective. In other words, the PRS was less expensive and more efficacious in terms of quality adjusted life years compared to usual screening technics. Moreover, results remained dominant for all scenario analyses. DSA and PSA also showed that results remained dominant in 100% of simulations from both perspectives.

CONCLUSIONS: This economic evaluation demonstrates that the PRS is a dominant option compared to usual screening methods, for the prevention of DN in patients with T2DM. The adoption of the PRS would not only be cost saving, but would also help prevent ESRD and improve patients’ lives.